Document Detail

Prognosis in moderate and severe traumatic brain injury: external validation of the IMPACT models and the role of extracranial injuries.
MedLine Citation:
PMID:  23354263     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: Several prognostic models to predict outcome in traumatic brain injury (TBI) have been developed, but few are externally validated. We aimed to validate the International Mission on Prognosis and Analysis of Clinical Trials in TBI (IMPACT) prognostic models in a recent unselected patient cohort and to assess the additional prognostic value of extracranial injury.
METHODS: The Prospective Observational COhort Neurotrauma (POCON) registry contains 508 patients with moderate or severe TBI, who were admitted in 2008 and 2009 to five trauma centers in the Netherlands. We predicted the probability of mortality and unfavorable outcome at 6 months after injury with the IMPACT prognostic models. We studied discrimination (area under the curve [AUC]) and calibration. We added the extracranial component of the Injury Severity Score (ISS) to the models and calculated the increase in AUC.
RESULTS: The IMPACT models had an adequate discrimination in the POCON registry, with AUCs in the external validation between 0.85 and 0.90 for mortality and between 0.82 and 0.87 for unfavorable outcome. Observed outcomes agreed well with predicted outcomes. Adding extracranial injury slightly improved predictions in the overall population (unfavorable outcome: AUC increase of 0.002, p = 0.02; mortality: AUC increase of 0.000, p = 0.37) but more clearly in patients with moderate TBI (unfavorable outcome: AUC increase of 0.008, p < 0.01, mortality: AUC increase of 0.012, p = 0.02) and patients with minor computed tomographic result abnormalities (unfavorable outcome: AUC increase of 0.013, p < 0.01; mortality: AUC increase of 0.001, p = 0.08).
CONCLUSION: The IMPACT models performed well in a recent series of TBI patients. We found some additional impact of extracranial injury on outcome, specifically in patients with less severe TBI or minor computed tomographic result abnormalities.
LEVEL OF EVIDENCE: Epidemiologic/prognostic study.
Hester Lingsma; Teuntje M J C Andriessen; Iain Haitsema; Janneke Horn; Joukje van der Naalt; Gaby Franschman; Andrew I R Maas; Pieter E Vos; Ewout W Steyerberg
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Publication Detail:
Type:  Journal Article; Multicenter Study; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  The journal of trauma and acute care surgery     Volume:  74     ISSN:  2163-0763     ISO Abbreviation:  J Trauma Acute Care Surg     Publication Date:  2013 Feb 
Date Detail:
Created Date:  2013-01-28     Completed Date:  2013-04-05     Revised Date:  2013-09-25    
Medline Journal Info:
Nlm Unique ID:  101570622     Medline TA:  J Trauma Acute Care Surg     Country:  United States    
Other Details:
Languages:  eng     Pagination:  639-46     Citation Subset:  AIM; IM    
Departments of Public Health, Erasmus Medical Center, Rotterdam, The Netherlands.
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MeSH Terms
Brain Injuries / complications,  diagnosis*,  mortality
Glasgow Coma Scale
Middle Aged
Models, Statistical
Multiple Trauma / complications,  diagnosis,  mortality
Netherlands / epidemiology
ROC Curve
Reproducibility of Results

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